| NPI | 1366424533 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X (Licence: RI MD11456) |
| Additional Taxonomies | 2085R0001X (Licence: MA 79255) |
| 2085R0001X (Licence: FL ME125691) | |
| Enumeration Date | 2005-11-15 |
| Last Update Date | 2020-12-21 |